Oncology Neutropenia Toolkit: An EBP Cancer Care Initiative

Susan E. Segreti, MS, MEd, NP-CChatham University

Conceptual Model for Prevention and Management of Chemotherapy-Induced

Neutropenia (CIN)

Issues

• ANC < 2000 mm3

• Common toxicity• Consequence - suboptimal therapy (dose reductions/delays)• Effects QOL• Loss of productivity• Increased hospital spending• Increased mortality and morbidity rates from infection

Process

• Iowa Model of EBP• Problem focused trigger (dose reductions and delays)• Knowledge focused trigger (NCCN Guidelines)• Priority – prevention and management of CIN• Process action team• Timeline• Gaps in the literature• Outcomes (Neutropenia Report Card)• Baseline data (prior 3 mo.)• Design (Neutropenia Algorithm)• Pilot• Evaluation of outcomes• Practice change• Ongoing assessment• Dissemination of results

Key Model Components

• Assessment of risk a) Regimen risk b) Patient risk (MASCC) c) QOL (FACT-N) d) ANC

• Plan a) > 20% risk consider CSF b) Identify family support members c) Schedule teaching session d) Promote partnership

• Intervention a) Neutropenia Toolkit b) Neutropenia Report Card c) Neutropenia Alert Card d) Administer CSF >20% risk • Evaluation a) ANC b) Neutropenic fever (NF) c) Complications – hospitalizations, dose reduction/delay

Practice Implications • Neutropenia is a serious global issue• Oncology nurses play a vital role • Standardized approach improves outcomes